In the event of a crisis:__________________________________________________

12. ANYTHING ELSE?

No____ Yes____

Explanation:__________________________________________

What will become of this form after the termination of the relationship?_________________________

NOTES AND FEEDBACK

How will the Dominant keep record and track the progress of the relationship?

_____ _

Will the submissive have access to these records? _____________________________________________________________________

Does the Dominant agree to maintain a safe environment for communication and growth between both parties; including but not limited to meeting to discuss concerns, accepting inquiries from the submissive regarding expectations/duties, and provide physical, mental , and emotional care and mutual respect? ____________________________________________________________________

Outline the agreed methods of tracking progress:

Outline the agreed methods of addressing concerns and making inquiries (submissive to Dominant):

APPENDIX D

RIGHTS & RESPONSIBILITIES OF SERVICE

I will obey you at all times and will wholeheartedly seek your pleasure and well-being above all other considerations.

I will attend to your needs before my own and will serve you in whatever function you may desire of me.

I will strive diligently to re-mold my body, habits and attitude in accordance with your desires, and will gracefully accept criticism and instruction.

I agree to wear as outward sign of ownership any items of decoration, permanent or semi-permanent marking at all times. I agree to wear a collar at all times where you deem appropriate. (Items should be listed specifically)

Within the limits of physical safety and my ability to earn a livelihood, I otherwise accept as your prerogative, anything you may choose to do with me, whether as punishment, or for your amusement.

I will maintain our home in a clean and tidy state, in addition to specific chores dictated by you at any time. If I need assistance with the daily chores due to work constraints I will ask for your assistance. If I do not ask for assistance and do not complete the chores, I will be subject to punishment.

I understand and agree that any failure by me to comply fully with your desires shall be regarded as sufficient cause for punishment and/or dismissal.

All interactions with other people, (play, personal time, dates) will be considered on a case by case basis. As the submissive I may not negotiate play with other people on my own. All arrangements must be made through my Dominant. Sexual contact or communication with outside people (anyone other than Dominant regardless of the relationship or previous friendship) is not permitted at all whether in jest or in earnest, and will be severely punished, including termination of the relationship.

I, (submissives name), acknowledge the importance of BDSM in our life and will work to keep the power exchange alive in our daily lives.

2. I place myself fully and with utmost trust into the hands of my (Dominants name or title) knowing full well that he/she respects me and cares for me and that no permanent injury shall deliberately be done to me.

3. I agree to hold my (Dominants name or title) harmless from any civil or criminal liability which may inure to me as a consequence of the actions agreed to in this contract; with the proviso that I do not relinquish the right to legal actions regarding any items specifically excluded from my part of this agreement.

4. My safe word is . I (shall/shall not) have the right to use it at any time during the term of this contract. If I have the right to use it and do so, the contract will [put the conditions to which the contract will be affected by use of the safe word.]

And I, as your (Dominants name or title), accept these terms of your submission to me. I will treat you with respect and will cherish you as My prized possession. I will strive to maintain discipline, consistency, and creativity in our lives.

Irequire compliance with the following rules: (List your specific rules)

1.

2.

3.

4.

5.

6.

7.

8.

9.

This contract, signed the (Date: Day, Month, Year) will remain in effect (length of contract), so long as Dominant and submissive remain in consensual relationship. Addenda and deletions can and will be made as necessary.

In witness whereof, we affix our signatures and seals the day and date this contract was written or revised:

Dominants Signature: Submissives Signature:

Title: Title:

Date: Date:

Signature of Witness or of Notary:

(If so desired, gives more weight to the contract as a legally binding document)